title: Long-term effectiveness of intravitreal bevacizumab for choroidal neovascularization secondary to angioid streaks in pseudoxanthoma elasticum.
abstract: OBJECTIVE
  To investigate the long-term effectiveness of intravitreal bevacizumab for treating active choroidal neovascularizations in pseudoxanthoma elasticum (PXE).
  
  
  METHODS
  Fourteen patients (16 eyes) received intravitreal bevacizumab (1.5 mg) and were investigated monthly. Further treatments were administered depending on disease activity. Examinations included best-corrected visual acuity, biomicroscopy, optical coherence tomography, fluorescein angiography and indocyanine green angiography, fundus autofluorescence, and digital fundus photography. Areas of atrophy of the retinal pigment epithelium and retinal fibrosis were quantified using semiautomated detection on fundus autofluorescence images.
  
  
  RESULTS
  Mean age of the cohort was 55 ± 13 years, and mean best-corrected visual acuity at baseline was 20/80 (logarithm of the minimum angle of resolution, 0.56, SD, 0.51). At last follow-up, after an average of 6.5 ± 5.7 injections over 28 months, best-corrected visual acuity was 20/40 (logarithm of the minimum angle of resolution, 0.31, SD, 0.32; P = 0.04). Central retinal thickness was reduced from 254 ± 45 μm to 214 ± 40 μm (P = 0.035). The size of retinal pigment epithelial atrophy and retinal fibrosis measured on fundus autofluorescence images increased in both the treated eye and the fellow eye (P < 0.05). Best-corrected visual acuity of patients with early disease compared with that of those with advanced disease improved significantly more over the treatment course (20/25 vs. 20/63; P = 0.008).
  
  
  CONCLUSIONS
  Intravitreal bevacizumab therapy demonstrates long-term effectiveness by preserving function in advanced disease and improving function in early disease. Best results of treating active choroidal neovascularizations in PXE are achieved when treatment starts the earliest possible.
authors.affiliation: Department of Ophthalmology, University of Bonn, Germany.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Finger
authors.forename: Peter
authors.initials: P
authors.lastname: Charbel Issa
authors.forename: Steffen
authors.initials: S
authors.lastname: Schmitz-Valckenberg
authors.forename: Frank G
authors.initials: FG
authors.lastname: Holz
authors.forename: Hendrik N
authors.initials: HN
authors.lastname: Scholl
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000793:Angioid Streaks / Q000150:complications* / Q000503:physiopathology; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D001284:Atrophy; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004396:Coloring Agents; D005260:Female; D005355:Fibrosis / Q000473:pathology; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011561:Pseudoxanthoma Elasticum / Q000150:complications* / Q000503:physiopathology; D055213:Retinal Pigment Epithelium / Q000473:pathology; D019233:Retreatment; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004396:Coloring Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D007208:Indocyanine Green